> Locally Advanced or Inflammatory Breast Cancer (Stage III)
Locally advanced breast cancer
Locally advanced breast cancer (stage III) has spread beyond the breast to the chest wall, the skin of the breast or to many lymph nodes in the underarm area (axillary nodes), but not to other organs.
Learn more about the stages of breast cancer.
Prognosis for locally advanced breast cancer
With treatment, the chance of surviving five years after diagnosis for women with stage IIIA breast cancer is 41 to 67 percent . These rates are averages, though, and vary depending on each person’s diagnosis and treatment. They are also based on women diagnosed with breast cancer in 2001 and 2002. With improvements in treatment since that time, survival for women diagnosed today may be higher.
Treatment for locally advanced breast cancer
Locally advanced breast cancer is treated with a combination of surgery, radiation and chemotherapy. Depending on certain tumor characteristics, treatment may also include hormone therapy and/or targeted therapy.
Treatment for locally advanced breast cancer usually begins with neoadjuvant (before surgery) therapy. Neoadjuvant therapy helps shrink the tumor(s) in the breast and lymph nodes so that surgery can better remove all of the cancer.
Most women get neoadjuvant chemotherapy, usually with an anthracycline-based chemotherapy and a taxane-based chemotherapy . When possible, all the chemotherapy planned to treat locally advanced breast cancer is given before surgery . If the tumor does not get smaller with one combination of chemotherapy drugs, other combinations can be tried.
If the tumor is HER2/neu-positive (HER2/neu+), neoadjuvant trastuzumab (Herceptin) may be given, but not at the same time as an anthracycline-based chemotherapy . Neoadjuvant pertuzumab (Perjeta) may be given in combination with trastuzumab .
Some postmenopausal women with hormone receptor-positive tumors may get neoadjuvant hormone therapy (usually with an aromatase inhibitor) .
In some cases, if the tumor does not respond to neoadjuvant therapy, radiation therapy may be given before surgery .
Learn more about neoadjuvant therapy.
Surgery, radiation therapy and adjuvant therapy
After neoadjuvant therapy, you will have surgery. Surgery is most often a mastectomy, but sometimes neoadjuvant therapy shrinks a tumor enough that a lumpectomy is possible. With either type of surgery, some lymph nodes in the underarm area (axillary nodes) are also removed.
Surgery is followed by radiation therapy. If all the chemotherapy was not given before surgery, more chemotherapy will be given after radiation therapy. Hormone therapy (such as tamoxifen or an aromatase inhibitor) or targeted therapy (such as trastuzumab) may also be given after radiation therapy .
Inflammatory breast cancer
Inflammatory breast cancer (IBC) is a rare but aggressive type of locally advanced breast cancer. It is called inflammatory breast cancer because its main symptoms are swelling and redness of the breast (the breast looks inflamed). These and other symptoms include :
- Swelling or enlargement of the breast
- Redness of the breast (may also be a pinkish or purplish tone)
- Dimpling or puckering of the skin of the breast
- Pulling in of the nipple
- Breast pain
Although sometimes a lump in the breast can be felt, it is less common with IBC than with other forms of breast cancer
With other forms of breast cancer, symptoms in the breast may not occur for years. However, with IBC, symptoms tend to arise within weeks or months. Because of the frequent lack of a breast lump and symptoms such as redness and swelling, IBC may first be mistaken for an infection. IBC is often diagnosed after symptoms do not improve with a course of antibiotics.
IBC tumors are often estrogen receptor-negative and HER2/neu-positive. Because these breast cancers are aggressive, most women with IBC have positive lymph nodes and 25 to 30 percent have metastasis when they are diagnosed . For this reason, when IBC is diagnosed, tests for metastatic breast cancer are done. Learn about tests for metastatic breast cancer.
The section below discusses treatment for non-metastatic IBC. Learn more about treatment for metastatic breast cancer.
Meet Ute Bankamp, a young woman living with inflammatory breast cancer.
Prognosis for inflammatory breast cancer
With treatment, up to 65 percent of those with IBC will live for five years after diagnosis and about 35 percent will be cancer-free 10 years after diagnosis [116-118]. These rates are averages, though, and vary depending on each person’s diagnosis and treatment. They are also based on women diagnosed with breast cancer more than 10 years ago. With current treatments, survival rates may be higher.
Treatment for inflammatory breast cancer
IBC is treated with a combination of surgery, radiation and chemotherapy, and may include hormone therapy and/or targeted therapy.
The first treatment for IBC is neoadjuvant (before surgery) chemotherapy, usually with an anthracycline-based chemotherapy and a taxane-based chemotherapy. Neoadjuvant chemotherapy helps shrink the tumor(s) in the breast and lymph nodes so that surgery can better remove all of the cancer. When possible, all the chemotherapy planned to treat locally advanced breast cancer is given before surgery . If the tumor does not get smaller with one combination of chemotherapy drugs, other combinations can be tried.
If the tumor is HER2/neu+, neoadjuvant trastuzumab (Herceptin) may also be given, but not at the same time as the anthracycline-based chemotherapy . Neoadjuvant pertuzumab (Perjeta) may be given in combination with trastuzumab .
In some cases, if the tumor does not respond to neoadjuvant chemotherapy, radiation therapy may be given before surgery .
Learn more about neoadjuvant therapy.
Surgery for IBC is almost always a mastectomy. Some lymph nodes in the underarm area (axillary nodes) are also removed.
For women choosing breast reconstruction, this surgery is not usually done at the same time as the mastectomy, but at a later time (“delayed” reconstruction). Delayed reconstruction is preferred because radiation therapy follows surgery .
Radiation therapy and adjuvant therapy
Surgery for IBC is followed by radiation therapy.
Adjuvant therapy (after surgery and radiation therapy) depends upon the type of tumor and prior treatment :
- If chemotherapy was not completed before surgery, the remaining chemotherapy is given after surgery.
- HER2/neu+ IBC is treated with trastuzumab (some trastuzumab may also be given before surgery).
- Hormone receptor-positive IBC is treated with hormone therapy.
Although the exact treatment for locally advanced breast cancer varies from person to person, guidelines help ensure quality care. These guidelines are based on the latest research and the consensus of experts. The National Comprehensive Care Network (NCCN) has specific guidelines for the treatment of IBC. The National Cancer Institute (NCI) also has overviews of treatment options.
Playing an active role
Understanding your breast cancer and your treatment options (including possible risks and benefits) help you play an active role in making treatment decisions. Together, you and your health care provider can choose treatments that best fit your values and lifestyle.
Learn more about factors that affect treatment options.
Learn more about mastectomy and lumpectomy.
Learn more about radiation therapy.
Learn more about chemotherapy.
Learn more about hormone therapy.
Learn more about trastuzumab (Herceptin).
Learn more about neoadjuvant therapy.
Research is ongoing to improve all areas of treatment for breast cancer. New therapies are being studied in clinical trials. The results of these studies will decide whether these therapies will become part of standard care. After discussing the benefits and risks with your health care provider, we encourage you to consider joining a clinical trial.
BreastCancerTrials.org in collaboration with Susan G. Komen® offers a custom matching service that can help you find a clinical trial that fits your health needs. Learn more about this program or search BreastCancerTrials.org for clinical trials on locally advanced breast cancer or clinical trials on inflammatory breast cancer.
Learn more about clinical trials.
In September 2013, the Institute of Medicine (IOM) released a set of recommendations (below) on improving cancer care in the U.S. The report Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis recommends improvements to fix shortcomings that add cost and burden to cancer care. In the U.S., there are about 14 million cancer survivors and more than 1.6 million new cases are diagnosed each year. By 2022, the IOM projects that there will be 18 million cancer survivors and, by 2030, cancer incidence is expected to rise to 2.3 million new diagnoses per year. Therefore, the IOM convened a committee of experts to examine the quality of cancer care in the U.S. and made recommendations for improvement. The committee concluded that the cancer care delivery system is in crisis due to a growing demand for cancer care, increasing complexity of treatment, a shrinking workforce and rising costs. Changes across the board are urgently needed to improve the quality of cancer care.
Susan G. Komen® endorses these recommendations as they have special significance in the breast cancer field. “Issues of accessibility, quality treatments and survivorship are especially complex for breast cancer patients, who may be treated for many years,” said Chandini Portteus, Komen’s Chief Mission Officer.
The report identified key ways to improve quality of care:
- Ensure that cancer patients are engaged and understand their diagnosis so they can make informed treatment decisions with their health care providers
- Develop a trained and coordinated workforce of cancer professionals
- Focus on evidence-based care, using information technology to provide better information about the potential benefits of treatments
- Focus on quality measurements
- Provide accessible and affordable care for all
The study was chaired by a Susan G. Komen Scholar Patricia Ganz, M.D., with participation by Komen’s Chief Scientific Advisor, George Sledge, M.D. Komen was one of 13 organizations sponsoring the study. Read the full report at www.nas.edu and www.iom.edu.
*Please note, the information provided within Komen Perspectives articles is only current as of the date of posting. Therefore, some information may be out of date at this time.